Chi-square Test Research Articles

Prostate Cancer Risk Prediction Model Using Clinical and Magnetic Resonance Imaging–Related Findings: Impact of Combining Lesions' Locations and Apparent Diffusion Coefficient Values

Objectives The aims of the study are to develop a prostate cancer risk prediction model that combines clinical and magnetic resonance imaging (MRI)–related findings and to assess the impact of adding Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesions-level findings on its diagnostic performance. Methods This 3-center retrospective study included prostate MRI examinations performed with clinical suspicion of clinically significant prostate cancer (csPCa) between 2018 and 2022. Pathological diagnosis within 1 year after the MRI was used to diagnose csPCa. Seven clinical, 3 patient-level MRI-related, and 4 lesion-level MRI-related findings were extracted. After feature selection, 2 logistic regression models with and without lesions-level findings were created using data from facility I and II (development cohort). The area under the receiver operating characteristic curve (AUC) between the 2 models was compared in the PI-RADS ≥3 population in the development cohort and Facility III (validation cohort) using the Delong test. Interfacility differences of the selected predictive variables were evaluated using the Kruskal-Wallis test or chi-squared test. Results Selected lesion-level features included the peripheral zone involvement and apparent diffusion coefficient (ADC) values. The model with lesions-level findings had significantly higher AUC than the model without in 655 examinations in the development cohort (0.81 vs 0.79, respectively, P = 0.005), but not in 553 examinations in the validation cohort (0.77 vs 0.76, respectively). Large interfacility differences were seen in the ADC distribution (P < 0.001) and csPCa proportion in PI-RADS 3–5 (P < 0.001). Conclusions Adding lesions-level findings improved the csPCa discrimination in the development but not the validation cohort. Interfacility differences impeded model generalization, including the distribution of reported ADC values and PI-RADS score-level csPCa proportion.

A diffusion tensor imaging-based multidimensional study of brain structural changes after long-term high-altitude exposure and their relationships with cognitive function

BackgroundBrain structure changes after long-term adaptation to the high-altitude environment; however, related studies are few, results are in consistent, and long-term effects on cognitive function and pathophysiological mechanisms are unclear. Therefore, diffusion tensor imaging (DTI) was used to investigate the damage to white matter fiber tracts and correlations between brain structural abnormalities and cognitive function.MethodsForty healthy Han people living on the high-altitude and 40 healthy Han people living on the plains were enrolled in this study and underwent magnetic resonance imaging, emotional state assessment, and cognitive function tests. The sex, age, education level, and social status of the two groups were not different. The tract-based spatial statistics (TBSS) method was used to analyze the DTI parameters of the white matter fiber tracts of the two groups. Moreover, the partial correlation method (age and sex as covariates) was used to analyze the correlations between the intergroup differences in the DTI parameters and a series of clinical indicators of emotional state and cognitive function. Two-sample t tests, Mann-Whitney U test, generalized linear model, or chi-square tests were used for statistical analysis.ResultsCompared with those individuals in the plain group, the scores on the PSQI, SDS, SAS, PHQ-9, and GAD-7 of individuals in the high-altitude group were higher, while the scores on the DST-Backwards, MoCA, and MMSE in the high-altitude group were lower. The fractional anisotropy (FA) value of the body of the corpus callosum in the high-altitude group was lower than that in the plain group. The FA value of the body of the corpus callosum in the plain group was negatively correlated with the Logical Memory, while no significant correlation was found in the high-altitude group.ConclusionThis study revealed that long-term exposure to a high-altitude environment could lead to a series of changes in sleep, emotion, and cognitive function and irreversible damage to the white matter microstructure of the body of the corpus callosum, which is the related brain region responsible for logical memory. The absence of logical memory impairment in the healthy Han Chinese population living on the high-altitude in this study may be due to the existence of adaptive compensation after long-term high-altitude exposure.

Exploring Non-Communicable Disease Risks in Postmenopausal Rural Women of Bangladesh: A Cross-Sectional Study

Background: Non-Communicable Diseases (NCDs) pose a significant health challenge globally, particularly in countries underwent rapid demographic transitions like Bangladesh. Rural populations, including postmenopausal women, are disproportionately affected by NCDs due to various socio-economic and lifestyle factors. This study aimed to investigate the prevalence of NCD risk factors among postmenopausal women in a rural village. This cross-sectional study was conducted in a rural village of Gazipur, Bangladesh from November 2023 to February 2024. Materials and methods: A sample of 108 postmenopausal women was selected using a convenience sampling technique. Data on socio-demographic characteristics, lifestyle habits and health outcomes were collected through structured interviews and assessments. Chi-square tests were employed to analyze the associations between sociodemographic variables, lifestyle factors and the presence of NCDs. Results: The study revealed a high prevalence of NCD risk factors among postmenopausal rural women. Engaging in physical activity for 2-4 hours daily was significantly associated with both Diabetes Mellitus (p 0.04) and Hypertension (p 0.006). Similarly, occupation showed a significant association with Hypertension (p 0.012) with housewives exhibiting higher prevalence rates. However, there were no significant associations between salt intake, sweet consumption and the presence of NCDs. Conclusion: This study highlights the urgent need for targeted interventions to address NCD risk factors among postmenopausal rural women in Bangladesh. Strategies focusing on promoting physical activity and addressing occupational factors could help mitigate the burden of NCDs in this vulnerable population. By understanding the socio-demographic and lifestyle determinants of NCDs, policymakers and healthcare providers can develop effective public health interventions tailored to the needs of rural communities. IAHS Medical Journal Vol 7(1), June 2024; 35-39

OGC SO46 - Improving outcomes after oesophagectomy: The benefits of full robotic-assisted minimally invasive oesophagectomy (RAMIO) demonstrated in the first 100 cases, at a high-volume UK unit

Abstract Background There is a rapid movement towards adoption of robotically assisted minimally invasive oesophagectomy (RAMIO) in the United Kingdom. Transition from an open or laparoscopic oesophagectomy to a RAMIO programme, which carries considerable financial and training cost, must ensure parity of oncological and perioperative outcomes. We sought to compare our centre’s results of the three standard approaches to two-phase oesophagectomy: Open/Open (Open); laparoscopic/robotic abdomen with open chest (Hybrid); and RAMIO. Method This prospective cohort study investigated the experience of five surgeons in a single high-volume UK institution. We analysed consecutive patients undergoing two-phase transthoracic oesophagectomy for oncological reasons between 2018 and 2024. The study period was divided into three cohorts: Open (2018-2020, n=61), Hybrid (2020-2023, n=82) and RAMIO (2023-2024, n=100). Patient demographics, tumour characteristics, perioperative outcomes, and oncological data were compared. Data were analysed using Kruskal-Wallis and Chi-squared statistical tests. Results No significant differences were observed in patient demographics or tumour stage between the groups. Comparison of Open vs. Hybrid vs. RAMIO demonstrated a significant reduction in major complications (Clavien-Dindo ≥III), 34.4% vs. 23.2% vs. 14% (p=0.0014); pulmonary complications, 36.1% vs. 25.4% vs. 13% (p=0.0004); anastomotic leak rate, 11.5% vs. 2.4% vs. 4.0%, (p=0.0370); median length of stay, 14 vs. 12 vs. 8 days (p=0.0001); and mortality, 4.9% vs. 1.2% vs. 0% (p=0.0133) all favouring the RAMIO group in sub-group analysis. Median lymph node yields were comparable across groups, 49 vs. 43 vs. 43 (p=0.0876). Conclusion This single-institution study demonstrates potential benefits of transitioning from open or hybrid to RAMIO for oesophagectomy. RAMIO was associated with significantly reduced pulmonary complications, major complications and a shorter length of hospital stay. Oncological outcomes were maintained across all 3 techniques. These findings have important patient, financial, and resource implications, and support the continued adoption of RAMIO in the UK.

BN SO20 - Day-case laparoscopic cholecystectomy: Predictors of failure

Abstract Background Laparoscopic Cholecystectomy (LC) is the main treatment option for symptomatic gallstone disease. It is commonly performed as a day case operation and Getting It Right First Time (GIRFT) have suggested that this should be the default position for all trusts. NHSE Model Hospital analyses hospital metrics and sets national benchmarks. They suggest that the day case rate for LC should be greater than 71.4%. The aim of our study is to analyse all elective LC’s over a two year period and identify factors that increase the likelihood of day-case failure and the common reasons for this. Method All patients who had LC between 1st July 2020 and 30th June 2022 were identified. All emergency cholecystectomies were excluded from analysis. Patient and operative details were retrieved from their electronic record and a Charlson co-morbidity index was calculated. Statistical analysis was performed using SPSS with Chi-squared tests performed for categorical data and ANOVA for continuous data. Odds ratios with 95% confidence intervals were calculated. Statistical significance was taken as p<0.05. Results 788 patients had elective cholecystectomies with 74.0% being successful day-case. Factors increasing day-case failure included: Admission with gallbladder disease within past year (OR 3.15 (2.26-4.37), CBD diameter>8mm (OR 2.17(1.44-3.26), thick-walled gallbladder (OR 2.20(1.59-3.04), on-table cholangiogram (OR 4.16 (2.21-7.84), sub-total cholecystectomy (OR 30.6(9.19-102) and male sex (OR 1.55(1.11-2.18). Patients who failed day-case had higher mean age (59 vs 49) and higher co-morbidity index (2.16 vs 1.44). The most common reasons for day-case failure were complex procedure (41%), and symptom control (35%). Only 20% had planned admissions. 30-day morbidity and re-admission rate were higher for failed day-case patients. Conclusion Our hospital complies with the day case benchmark set out by Model Hospital. Furthermore, only 5.2% of patients undergoing elective cholecystectomy had a pre-operative decision for an inpatient stay demonstrating that day case is the default for the vast majority of patients. Despite this, improvement could still be made with post-operative symptom control to try and increase this number further.

Effect of match location on the playing style of teams coached by ‘Pep’ Guardiola

IntroductionAnalysis in football seeks to find the performance factors that bring teams closer to success.MethodsThis study aims to analyze the playing styles of two teams managed by Pep Guardiola (F.C. Barcelona and Manchester City) based on match location (home or away). Two methods of analysis were used: descriptive statistics through chi-square tests to evaluate game characteristics and the polar coordinates technique to analyze the relationships between the different lines of each team (goalkeeper, defenders, midfielders, and forwards).ResultsThe results showed that F.C. Barcelona maintained a consistent playing style regardless of location, exhibiting significant differences only in actions that involved shots or header (p = 0.035), with better performance at home. In contrast, Manchester City displayed significantly different performance in action success (p < 0.001), level of play elaboration (p = 0.004), density (p = 0.033), duration (p = 0.036), and actions that included a shot (p = 0.001) depending on the location. Additionally, qualitative analyses revealed differences in the relationships among the team lines according to match location, with Manchester City displaying more variability in these interactions than F.C. Barcelona.DiscussionThe study concludes that although Guardiola applies a consistent set of strategies, match location has a greater influence on Manchester City’s performance, suggesting that this team adjusts its playing style on the basis of contextual conditions. These findings highlight the importance of considering factors such as location when preparing tactics to increase the probability of success in elite football.

EGS SO08 - How best to time the operative management of acute cholecystitis: Is there a difference in outcomes between hot and smouldering cholecystectomy?

Abstract Background Laparoscopic Cholecystectomy (LC) is the main treatment for symptomatic gallstone disease. Acute cholecystitis (AC) is a common emergency presentation in the UK and the 2015 AUGIS guidelines recommend emergency cholecystectomy within 72 hours of admission if the patient is fit. On a practical level this can sometimes be difficult to implement and often patients are discharged to return for an elective procedure (the smouldering gallbladder). We aimed to analyse our practice at a large district general hospital for the management of patients with AC and their post-operative outcomes. Method All patients undergoing LC between 1st July 2020 and 30th June 2022 were identified. Patients with an ICD-10 code of K81 (AC) associated with an inpatient stay within a year of their operation were included. Those admitted and operated on during that admission were classified as hot cholecystectomies (HC), whereas those admitted and discharged for an elective procedure were termed smouldering cholecystectomies (SC). Patient and operative details were retrieved from their electronic record and a Charlson co-morbidity index was calculated. Statistical analysis was performed using SPSS with Chi-squared tests performed for categorical data and ANOVA for continuous data. Results 276 patients underwent cholecystectomy for AC with 52.2% elective and 47.8% emergency (91% within 72 hours of admission). HC patients were younger (52.3 vs. 57.5, p<0.01) and less-comorbid (1.67 vs 2.12, p<0.05). The subtotal cholecystectomy rate was comparable between the groups (9.8% vs 16.0%, p=0.131). HC patients had more post-operative drains (38.6% vs 27.1%, p<0.05) and thick-walled gallbladders (92.4% vs 64.6%, p<0.001). Median post-operative length of stay was 1 day for HC and 0 days for SC. No difference was observed for 30-day readmission (4.5% vs 7.6%, p=0.286), morbidity (12.9% vs 11.8%, p=0.786) or mortality (0.8% vs 0.7%, p=0.951). Conclusion This study adds to the evidence that emergency cholecystectomy is as safe an option as discharging patients to return for an elective procedure in the future. Although a proportion of those discharged to return for an elective operation will have thin-walled gallbladders, the rate of subtotal cholecystectomy remains similar, if not slightly higher in the elective group (although not reaching statistical significance). Most emergency cholecystectomy patients were discharged the following day, therefore demonstrating that they do not significantly contribute to bed blocking and reduce the burden on already strained elective waiting lists.

The Impact of Cariogenic Food Consumption on Dental Caries Rates Among Children

Background: The most well-known dental and oral infection is dental caries. The hard tissues of the teeth, such as enamel, dentin, and cementum, become infected with dental caries over time. Dental caries can cause torment that frustrates everyday exercises, prevents fixation, and might in fact make loss of hunger due trouble biting. This study means to dissect the connection between utilization of cariogenic food varieties and the occurrence of dental caries in youngsters at RA Al-Fattah Gresik. Method: The sort of exploration utilized is logical and observational utilizing a cross sectional plan. The populace was 112 kids and the example utilized was 88 youngsters utilizing basic irregular testing procedures. In this review, the FFQ (Food Recurrence Quotionnaire) survey was utilized. Factual tests use Chi-square. Results: The aftereffects of this study showed that of the 88 respondents who experienced dental caries, there were 37 kids (42.0%) and 49 youngsters (55.7%) ate cariogenic food varieties with elevated degrees of utilization. The Chi-Square test analysis yielded p-values of 0.000 and 0.005 respectively, Conclusion: There is a connection between utilization of cariogenic food varieties and the occurrence of dental caries in youngsters at RA Al-Fattah Gresik. Keywords: Dental Caries, Cariogenic Food

HPB SO66 - Has the Complexity of Laparoscopic Cholecystectomies Increased Following the COVID-19 Pandemic?

Abstract Background Laparoscopic cholecystectomy (LC) is recognized for its diverse complexity between cases, which profoundly influences perioperative progression and patient outcomes. It is notoriously difficult to accurately predict surgical complexity pre-operatively. The COVID-19 pandemic notably contributed to substantial delays in the definitive management of gallstone disease. The present study aimed to compare the intraoperative complexity grading of LCs performed post-pandemic with data previously reported in the literature. Method A prospectively collected database of all LCs and laparoscopic common bile duct exploration (LCBDE) performed between August 2022 and June 2024 was analysed. The database was populated from a single benign biliary center by two specialized biliary surgeons. The study focused on clinical and intraoperative parameters, with particular emphasis on assessing the cholecystectomy operative difficulty using the Nassar scale. Parameters from the database were compared with previously published data from a single surgeon over a 29-year period (n=5,391 cases). P value was calculated using Pearson uncorrected chi-square test. Results 201 patients were eligible for inclusion. Median age was 54 years (IQR 40-66) and 124 (61.7%) were female. 86 (42.8%) were emergency cases. 118 (58.7%) patients were classed as socially and economically deprived. 80 (39.8%) cases were carried out for acute cholecystitis and 48 (23.9%) were for gallstone pancreatitis. 52 (25.8%) underwent LC alone, 89 (44.3%) also had intra-operative cholangiogram and 60 (29.9%) underwent LCBDE. Grade-1 LC (33.2% vs 8%, p<0.001) were significantly less prevalent than grade-4 LC (14.2% vs 33.8%, p<0.001) in the post pandemic period when compared to the previous published data. Conclusion The present study suggests there has been an increase in the complexity and operative difficulty of LC in the immediate post COVID-19 pandemic period. The reasons are likely multifactorial, however delays in the timely management of gallstone disease, resulting in repeated episodes of acute inflammation is hypothesised to be the key driving factor. Minimising a delay to definitive treatment through the establishment of efficient dedicated biliary care pathways could reduce the incidence of complex LC. Further work is required to determine if reducing the incidence of complex LC has a beneficial impact on complications and length of hospital stay.

Dietary Habits, Nutritional Knowledge, and Their Impact on Thyroid Health in Women: A Cross-Sectional Study

Background: The thyroid gland plays a crucial role in regulating metabolism and various bodily functions through hormone production. Women are particularly susceptible to thyroid disorders such as hypothyroidism and Hashimoto’s disease, with associated symptoms affecting overall well-being. Prior research has inadequately addressed the influence of dietary habits and nutritional knowledge on thyroid health, especially in women. Objective: This study aimed to evaluate the dietary habits and nutritional awareness of women aged 18–45 with diagnosed thyroid disorders, emphasizing the effects of education level on knowledge and dietary practices. Material and Methods: A cross-sectional survey was conducted with 297 women diagnosed with thyroid conditions. The survey assessed demographics, comorbidities, hydration habits, and knowledge about nutrient intake critical for thyroid health. Chi-square tests, ANOVA, and correlation analyses were performed to evaluate associations. Results: Hypothyroidism and Hashimoto’s disease were most prevalent among younger women (18–25 years). A significant association was observed between higher education and knowledge of protein and carbohydrate roles in managing thyroid health (p < 0.01). Women with higher educational backgrounds more frequently used healthier cooking methods and were more informed about beneficial nutrients, including vitamin D and omega-3. A chi-square test indicated that low water intake was significantly associated with comorbid conditions, including insulin resistance and cardiovascular disease (p < 0.01). Conclusions: Significant gaps remain in dietary knowledge, particularly concerning protein intake and nutrient–drug interactions, indicating a need for targeted dietary education. Women with higher education demonstrated greater dietary awareness, emphasizing the importance of tailored educational interventions to enhance thyroid disorder management.

Strength Training Among Male Master Cyclists—Practices, Challenges, and Rationales

Background: Cycling performance declines with age due to reduced aerobic capacity, along with reductions in muscle mass and bone density. Strength training can help counter these effects. This study aims to explore the strength training practices, challenges, and decision-making rationale of male master cyclists to optimize performance and health as they age. Methods: A total of 555 male master cyclists aged 35 and above completed an online questionnaire, distributed via social media platforms, that included Likert-type, single- and multiple-selection, and open-ended questions. Participants were then divided into two age groups: 35–49 years (n = 359) and ≥50 years (n = 196). Analyses involved descriptive statistics, Wilcoxon signed-rank tests, Mann–Whitney U-tests, and chi-square tests, with qualitative data analyzed using content analysis. Results: More cyclists engaged in strength training during the off-/pre-season, with a significant reduction in both frequency and the number of cyclists engaging in strength training during the race season. The strength training practice was focused mainly on core and lower body, employing hypertrophy and maximal strength training methods. Key challenges included fatigue induced by strength training and limited time to perform strength training. The main rationale for the strength training revolved around improving cycling performance, reducing injury risk, and the health benefits of strength training. Both age categories, but the older group in particular, reported bone health as a primary rationale for strength training. Conclusions: While strength training offers performance and health benefits, issues of fatigue and time constraints remain substantial, suggesting the need for tailored training programs to improve adherence and effectiveness.

Hedonic and eudaimonic personal goals as drivers to attend a religious mega event

ABSTRACT This study aims to explore the significance of hedonic and eudaimonic personal goals as drivers for attending a religious event, and their variability according to demographic variables. World Youth Day (WYD) was selected as a research context, and the sample accounts for 171 valid responses to a face-to-face survey of pilgrims. Data were subjected to a descriptive analysis to identify the level of importance of personal goals, and chi-square tests were also performed to assess the influence of socio-demographic characteristics on personal goals. The results confirm that hedonia and eudaimonia function as drivers of the decision-making process by shaping the motivations that drive individuals to participate in a religious event. Also, it was found that mainly sex, age and country of residence produce variations in personal goals. This study offers further evidence that goes beyond the general motivations of attendants to religious events, contributing to a new theoretical approach, including hedonic and eudaimonic goals.

Abstract 4119908: Outcomes for heart failure patients with reduced ejection fraction attending emergency department and discharged within 24 hours versus those admitted patients in heart failure unit.

Introduction: Heart failure (HF) is a clinical syndrome with increasing prevalence. Currently, there are extensive evidence-based therapies targeted at managing patients with heart failure and reduced ejection fraction (HFrEF) to improve outcomes. The National Heart Failure Audit shows the quality of inpatient care (specialist review, discharge medication etc) is related to outcome. This study aimed to evaluate the current practice at a London tertiary centre hospital in managing patients with heart failure and compared outcomes in patients who had a short course of admission (less than 1 day) with those who had a more prolonged course of admission. Method: Retrospective data was collected from a London tertiary centre hospital database for consecutive patients from Sep/2022 till Sep/2023. Statistical analysis was performed using Chi-Square test. The eligibility criteria included a new or previous diagnosis of HF with left ventricular ejection fraction (LVEF) < 40%. Patients were divided into two groups: Group A included 40 eligible patients who were admitted and discharged from the emergency department (ED) within 24 hours. Group B included 37 eligible patients who were admitted and discharged from the dedicated heart failure unit after 10-15 days of hospital admission. Results: In Group A, prescribing guideline-directed medical therapy (GDMT) was lower compared to Group B; Renin-Angiotensin-Aldosterone Inhibitors (47.50% vs. 94.59%), beta blockers (55% vs. 91.89%), mineralocorticoid receptor antagonists (12.50 %vs. 94.59%), and sodium-glucose co-transporter 2 inhibitors (15% vs. 89.19%). More patients in Group B received all four pillars of GDMT (86.49%) compared to Group A (5%). At 6-month follow-up,18.75% were on 4 GDMT in Group A versus 92% in group Group B. Re-admission within 6 months was higher in Group A (30%) compared to Group B (16.22%); however, the difference was not statistically significant (P value: 0.153). Higher mortality rates were observed in Group A (mortality rate: 20%) compared to Group B (mortality rate: 2.70%), with statistical significance (P value: 0.018). Conclusion: This study showed that HFrEF patients admitted to a specialist heart failure unit achieve higher rates of GDMT and have significantly improved outcomes compared to those who had a shorter inpatient stay and discharged from the emergency department. These findings underscore the high risks associated with rapid discharge from hospital on incomplete medical therapy.

Abstract Su205: Using Emergency Medical Services Monitors for Cardiac Arrest Patients in the Emergency Department is Associated with Faster Initial Rhythm Analysis and Defibrillation

Introduction: The 2020 American Heart Association guidelines for Cardiopulmonary Resuscitation (CPR) emphasizes the importance of high-quality CPR and early defibrillation in improving cardiac arrest (CA) survival. Using our emergency department (ED) CA video review registry, we can capture metrics to reliably assess the effectiveness of different approaches to CA management. Goals/Hypothesis: We propose that emergency medical services (EMS) pads and defibrillators should be used to initially analyze cardiac rhythm in the ED. We hypothesize that this “EMS Equipment” approach is associated with shorter time to first ED rhythm detection and defibrillation, higher chest compression fraction (CCF), and improved return of spontaneous circulation (ROSC) rates. Methods: This is a single center, retrospective cohort study using our CA video review registry between 10/03/2018 – 2/20/2024. Atraumatic, out-of-hospital CA patients ≥18 years were included while patients arriving to the ED with ROSC were excluded. The “EMS Equipment” group utilized EMS pads and defibrillators while the “ED Equipment” group utilized ED pads and defibrillators for the first ED rhythm analysis. Wilcoxon rank sum tests were used to assess differences in time to first rhythm check and first defibrillation among the two groups. Chi-square tests were used to assess whether the proportions of patients achieving above median CCF, ROSC, survival to admission and discharge in the two groups were different. Results: A total of 247 patients were included in the analysis with 69 patients in the EMS Equipment group (27.9%) and 178 patients in the ED Equipment group (72.1%). The EMS Equipment group had a shorter median time to first ED rhythm detection (96 vs. 255 seconds, p <0.00001). Among the 63 patients defibrillated in the ED, the EMS Equipment group had a shorter median time to first ED defibrillation (103 vs. 413 seconds, p = 0.0024). There was no significant difference in CCF, ROSC rates, survival to admission or discharge. ROSC was achieved in 36% of cases. Conclusion: In conclusion, initial rhythm analysis with EMS pads and defibrillators was associated with shorter time to initial ED rhythm detection and defibrillation, but not improved CCF, ROSC rates, and survival. Larger studies are needed to verify these exploratory results in more diverse settings.

Abstract 4137855: Hybrid Coronary Revascularization versus Traditional Coronary Artery Bypass Grafting for Left Main Disease

Background: The current guideline-recommended intervention for left main (LM) disease is coronary artery bypass grafting (CABG). Hybrid coronary revascularization (HCR) combines robotic coronary artery bypass and percutaneous coronary intervention (PCI) and offers a less invasive approach for patients with LM and multivessel coronary artery disease. We aim to compare clinical outcomes at 30 days, 6 months and 1 year between HCR and CABG in patients with LM disease. Methods: We retrospectively screened 761 patients who underwent bypass for LM disease between 2019 and 2023 at a single institution. A total of 118 patients who underwent either HCR (n=59) or CABG (n=59) were included after propensity matching for baseline characteristics. The primary endpoint was major adverse cardiovascular events (MACE), defined as death, myocardial infarction, repeat revascularization and stroke, at 30 days, 6 months and 1 year, which was assessed using chi-squared tests. Secondary outcomes are individual components of MACE at 30 days, 6 months and 1 year. Kaplan-Meier curves were used to visualize the difference in 1-year cumulative MACE-free survival across groups coupled with a log-rank test. Results: The mean age was 68.93±11 years for HCR patients and 68.41±10.11 years for CABG patients (p=0.394). SYNTAX score was high (> 33) for 49.1% of HCR patients and 67.3% of CABG patients (p=0.15). Hospital length of stay was shorter for HCR compared to CABG (4.07 ± 1.21 days vs. 7.58 ± 7.71 days, p<0.001). MACE events were significantly lower in the HCR group at 30 days (0% vs 10.2%; p=0.01), 6 months (0% vs 17%; p=0.002) and 1 year (2.4% vs 20.5%; p=0.01). The cumulative MACE-free survival at 1 year was significantly higher in the HCR group (p=0.007). There were no significant differences in secondary outcomes at any time point with the exception of lower repeat revascularization at 6 months in the HCR group (0% vs 10.9%; p=0.02). Conclusion: This retrospective study demonstrates that HCR is a viable alternative to CABG for LM disease. While randomized clinical trial data is still needed, this less invasive approach is a promising treatment strategy for patients with high surgical risk.

Subclinical Hypothyroidism and Gestational Hypertensive Disorders in a Cohort of Romanian Pregnant Women with Gestational Diabetes Mellitus: A Pilot Study

Objective: This study aimed to explore whether subclinical hypothyroidism (SCH) treated with levothyroxine in pregnancy complicated by gestational diabetes mellitus (GDM) is associated with an increased risk of gestational hypertensive disorders (GHDs) (gestational hypertension and preeclampsia). Methods: 96 pregnant women with GDM were enrolled in this study and grouped as per the European Thyroid Association criteria into the SCH (n = 21) and euthyroid groups (n = 75). All subjects were tested for anthropometric parameters, maternal glucose homeostasis parameters, lipid levels, thyroid function tests, and blood pressure. All GDM pregnant women received nutritional and insulin therapy where needed, and the SCH group received levothyroxine treatment. Then, the maternal and newborn outcomes were compared. Data were analyzed using Student’s t-test, Mann–Whitney U, and Chi-square tests wherever applicable. p values of <0.05 were considered significant. Results: Patients with GDM and SCH had a pre-pregnancy BMI and BMI at inclusion in the study smaller than those of the euthyroid group (p = 0.0004, p = 0.0009). There were no significant differences between groups regarding the incidence of GHD, preterm prelabor rupture of membranes (PPROMs), macrosomia, low birth weight, and fetal distress (p > 0.05). Patients with GDM and SCH treated with levothyroxine had more premature delivery than the euthyroid group (p = 0.03). Conclusions: Subclinical hypothyroidism treated with levothyroxine in women with GDM does not increase the risk of gestational hypertensive disorders, but is associated with increased risk for prematurity.

The effect of lumbar multifidus muscle degeneration on upper lumbar disc herniation

PurposeThis study aimed to investigate the effect of lumbar multifidus muscle (MF) degeneration on upper lumbar disc herniation (ULDH).MethodsThis study used 3.0T magnetic resonance imaging (MRI) T2 axial weighted images to retrospectively analyze 93 ULDH patients and 111 healthy participants. Sixty-five pairs of participants were included in this study using propensity score matching (PSM). Cross-sectional area, fat infiltration area, anteroposterior diameter (APD), lateral diameter (LD), cross-sectional area of the bilateral multifidus muscles at the corresponding level, intervertebral disc area at the corresponding section, and visual analog scale (VAS) score for low back pain (LBP). For inter-group comparisons, we used the t-test, analysis of variance (ANOVA), Mann–Whitney U test, Kruskal–Wallis test, chi-square test, or Fisher's exact test, according to the type of data. We used Pearson correlation analysis to study the correlation between the VAS score and related indicators, and established a predictive model for upper lumbar disc herniation using the receive operative characteristic (ROC) curve analysis method. Finally, univariate and multivariate logistic regression analyses were performed to establish a predictive model for the risk of high lumbar disc herniation.ResultsWe compared the fat areas at the lumbar vertebral levels L1/2, L2/3, and L3/4, as well as the left lateral diameter (LD) (MF), L1/2 left lumbar multifidus muscle index (LMFI), and L1/2 total fat infiltration cross-section area (TFCSA), and found significant differences between the case and control groups (P < 0.001). Furthermore, we observed a significant positive correlation (P < 0.05) between the VAS scores and multiple muscle indicators. Additionally, we developed ROC prediction models to assess the risk of lumbar intervertebral disc protrusion at the L1/2, L2/3, and L3/4 levels, with the results identifying L1/2 TFCSA, L2/3 TFCSA, and L3/4 relative psoas major muscle cross-section area (rPMCSA) as the most predictive indicators. Finally, univariate and multivariate logistic regression analyses showed that the L1/2 rPMCSA, L2/3 TFCSA were significantly associated with the risk of lumbar intervertebral disc protrusion in both models.ConclusionDegeneration of the MF is significantly correlated with the occurrence of ULDH, and the larger the area of fat infiltration in the MF, the more obvious the lower back pain in ULDH patients. In addition, TFCSA can serve as an indicator of the occurrence of ULDH.

Study of Bacteriological Content and Risk Factors of Drinking Water Consumption Patterns in Cases of Stunting Toddler

Stunting is one of global nutrition problems, especially in developing countries including Indonesia. The prevalence of stunting in Demak Regency, Indonesia, in 2021 was 4.34%, and in 2022 it was 2.99%. However, stunting problem remains a priority because the impact of stunting can hinder efforts to enhance the health of the society and the development of the quality of human resources. Risk factors for stunting are influenced by behavioral aspects of the environment, like sanitation and drinking water. This study aimed to determine the content of bacteriological factors that contribute to the risk pattern of drinking water consumption in cases of stunting toddlers in Temuroso Village, Working Area of Guntur I Health Center, Demak Regency, Indonesia. This study was a quantitative observational case study. The population included families and toddlers in Temuroso Village, totaling as many as 854 people. The sampling technique was purposive sampling, so the sample size was 182 people for cases and controls. Data analysis used Chi-Square test and linear regression test. The bacteriological content was predominantly negative (66.5%), with the majority of subjects showing no infections (67%). Most participants fell into the high drinking water consumption category (62.1%). Stunting incidence was significantly associated with bacteriological content (p <0.0001) and drinking water consumption patterns (p <0.0001). Among these, bacteriological content was the most dominant factor influencing stunting (exp B =0.199). In summary, the primary risk factors for stunting among toddlers in Temuroso Village, within the Guntur I Health Center working area, Demak Regency, were bacteriological content (p <0.000) and drinking water consumption patterns (p <0.000).

The influence of parenting styles and coping strategies on anxiety symptoms in adolescents: a comparative study of groups with and without non-suicidal self-injury behavior

Background During the COVID-19 pandemic, the global incidence of non-suicidal self-injury (NSSI) has been increasing year by year, especially among adolescents, and it is highly correlated with the level of anxiety among teenagers, particularly within Chinese cultural contexts where parenting styles significantly influence adolescent behavior. Objective This study examines the role of culturally-influenced parenting styles and adolescent coping strategies in relation to anxiety and NSSI behavior, aiming to clarify these multivariate interactions for better understanding and intervention. Methods A cross-sectional survey was conducted with NSSI-diagnosed adolescents from Affiliated Kangning Hospital, Ningbo, China, and healthy adolescents from urban schools. Data on background, parenting styles, coping strategies, and anxiety levels were analyzed using chi-square tests, independent sample t-tests, MANOVA, and regression analysis. Results Adolescents with NSSI reported higher anxiety levels, more punishment and interference, and less emotional warmth from their fathers compared to the non-NSSI group (p < 0.001). The NSSI group also relied more on emotion-oriented coping strategies, while the non-NSSI group favored problem-oriented approaches (p < 0.001). Multivariate analyses confirmed significant effects of NSSI behavior, parenting styles, and coping strategies on anxiety levels. Conclusion This study found that the anxiety levels of NSSI adolescents were significantly higher than those of non-NSSI adolescents in China, which was closely related to less emotional warmth from parents, more punishment and interference, and emotion-focused coping strategies. The results demonstrate that family environment and coping strategies play a critical role in NSSI behavior and anxiety levels, highlighting the importance of emphasizing emotional support and positive coping strategies in the prevention and intervention of NSSI behavior.

Influence of Blood Sampling Service Process Reengineering on Medical Services Supply: Quasi-Experimental Study

Background Tertiary hospitals in China are confronted with significant challenges due to limited spatial capacity and workforce constraints, leading to saturated allocation of medical resources and restricted growth in medical service provision. The incorporation of digital health into medical service process reengineering (MSPR) marks a pivotal transformation and restructuring of conventional health service delivery models. Specifically, the application of MSPR to blood sampling services processes reengineering (BSSPR) holds promise for substantially enhancing the efficiency and quality of medical services through streamlining and optimizing these procedures. However, the comprehensive impact of BSSPR has been infrequently quantified in existing research. Objective This study aims to investigate the influence of BSSPR on the efficiency and quality of medical services and to elucidate the key informative technological support points underpinning BSSPR. Methods Data were collected from both the new and old laboratory information systems from August 1, 2019, to December 31, 2021. A combination of statistical description, chi-square test, and t test was used to compare check-in time and waiting time of outpatients before and after the implementation of BSSPR. An interrupted time-series design was used to analyze the impact of BSSPR on medical service efficiency and quality, enabling the control of confounding variables, including changes in medical human resources and both long- and short-term temporal trends. Results BSSPR had an impact on the efficiency and quality of medical services. Notably, there was a significant increase in the number of patients receiving blood sampling services, with a daily service volume increase of ~150 individuals (P=.04). The average waiting time for patients decreased substantially from 29 (SD 36) to 11 (SD 11) minutes, indicating a marked improvement in patient experience. During the peak period, the number of patients receiving blood sampling services per working hour statistically increased from 9.56 to 16.77 (P<.001). The interrupted time-series model results demonstrated a reduction in patients’ waiting time by an average of 26.1 (SD 3.8; 95% CI –33.64 to –18.57) minutes. Although there was an initial decline in the number of outpatients admitted following BSSPR implementation, an upward trend was observed over time (β=1.13, 95% CI 0.91-1.36). Conclusions BSSPR implementation for outpatients not only reduced waiting time and improved patients’ experience but also augmented the hospital’s capacity to provide medical services. This study’s findings offer valuable insights into the potential advantages of BSSPR and underscore the significance of harnessing digital technologies to optimize medical service processes. This research serves as a foundational basis and provides scientific support for the promotion and application of BSSPR in other health care contexts. By continuing to explore and refine the integration of digital technologies in health care, we can further enhance patient outcomes and elevate the overall quality of medical services.