Combination Of Tests Research Articles

The importance of combined use of spacing and testing effects for complex skills training: A quasi-experimental study

Introduction A major challenge is retention of complex clinical skills. Spacing training and testing have been demonstrated to increase knowledge and skill retention but the combination has not been previously investigated in complex clinical skills. The aim of our study was to compare the effectiveness of combined spacing and testing for Basic Life Support (BLS) and Advance Life Support (ALS) simulation training in one group (intervention group), with combined spacing and testing, and another group (control) that received simulation training in a single-session simulation training without testing. Methods A quasi-experimental study. Results Thirteen nursing students were in the intervention group and 18 in the control group. After three months, there was no significant reduction in retention of BLS knowledge (p > 0.05) or BLS skills (p < 0.05) in the intervention group, but there was a significant reduction in both (p < 0.05) in the control group. We found no significant reduction in retention of ALS knowledge in the control group (p > 0.05), but there was a significant reduction in the intervention group (p < 0.05). There was no significant decay of ALS skills in both groups (p < 0.05). Discussion This is the first study to demonstrate that combined spacing and testing could be highly effective for complex skills simulation training to increase retention after three months.

Abstract 4141469: Left Ventricular Septum Displacement Implications in the Limited Cardiac Reserve, RV to Pc Uncoupling and Oxygen Uptake During Exercise in Heart Failure

Background: Dyspnea on exertion is cardinal symptom in heart failure (HF) and may be caused by an unfavorable dynamic of ventricular interaction. This concept has been poorly addressed over time and we hypothesized that a careful study of the interventricular septum adaptations during maximal exercise in HF might be implicated in the limited cardiac reserve and uncoupling of right ventricular (RV) to pulmonary circulation (Pc), both yielding to a limited O2 uptake. Aim: To study the pathophysiology behind biventricular interaction during exercise in HF, evaluating the role of septum displacement during exercise and how and whether it would affect peak exercise oxygen consumption (VO 2 peak) through a limited cardiac output (CO) increase and some degrees of RV to PC uncoupling assessed by TAPSE/PASP. Methods: 22 HF performed a combined cardiopulmonary exercise testing imaging (CPET imaging) with RV 3D-imaging analysis and were compared with a control population. 3D imaging of the RV chamber was examined off-line using the 4D RV TomTec software and obtained 3D mesh of the RV model using custom software to obtain the mean curvature value of IVS in 4 regions of: inflow tract (RVIT), outflow tract (RVOT), apical and body. We acquired measurements of curvature during end-diastole (ED) and at end systole (ES) phases and obtained a parametric curvature map. Results: HF patients (mean age 72±12, 27% female) typically showed an abnormal septal curve, with a more leftward configuration either at rest and under exercise (rest =−0.01±0.007 at ED, and −0.01±0.009 at ES; peak exercise= −0.01±0.006 at ED, and −0.01±0.007 at ES) compared to controls (rest=−0.02±0.002 at ED, and −0.02±0.006 at ES; peak exercise −0.02±0.0.006 at ED, and −0.02±0.01 at ES, Figure). Notably, the degree of the IVS curvature showed a linear correlation with an impaired gas exchange performance as indicated by a lower peak VO 2 , a limited CO and impairment of TAPSE/PASP in HF (respectively, r=0.64, p&lt;0.001, r=0.5, p&lt;0.001, r=0.53, p&lt;0.001 at ED during exercise; r=0.61, p&lt;0.001 at ES during exercise; Figure). Conclusions: In HF, the evidence of right to left IVS displacement appears worth of investigation, by intervening strictly to a reduced CO response, and RV-PA uncoupling during exercise. These findings clearly point to the utility of assessing how new and current therapeutic strategies may modulate the negative septum displacement and overall cardiac mechanics.

Who and how to screen for endogenous hypercortisolism in patients with mood disorders.

A strict association exists between mood disorders and endogenous hypercortisolism, namely Cushing's syndrome (CS). Indeed, CS is characterized by a wide range of mood disorders, such as major depression, generalized anxiety, panic disorders, bipolar disorders up to psychosis, with major depression being the most frequent, with a prevalence of 50-80%, and potentially representing the clinical onset of disease. Despite this observation, the exact prevalence of hypercortisolism in patients with mood disorders is unknown and who/how to screen for endogenous hypercortisolism among patients with mood disorders is still unclear. In this context, an accurate anamnestic and clinical examination are crucial in order to identify those patients who may benefit from CS screening. In particular, the presence of specific signs and symptoms of CS, comorbidities typically associated with CS, and lack of improvement of depressive symptoms with standard treatments can further guide the decision to screen for CS. Anyhow, it is noteworthy that mood disorders represent a cause of functional activation of hypothalamic-pituitary-adrenal (HPA) axis, a condition formerly known as non-neoplastic hypercortisolism (NNH). The differential diagnosis between CS and NNH is challenging. Beyond anamnestic and clinical features, various tests, including measurement of daily urinary cortisol and late-night salivary cortisol, together with low dose-dexamethasone suppression test, are used for initial screening. However, considering their low accuracy, a definitive diagnosis may require a longitudinal follow-up along with second-line dynamic tests like combined dexamethasone-CRH test and desmopressin test. In conclusion, available data suggest the need for a comprehensive assessment and follow-up of individuals with mood disorders to detect possible underlying CS, considering the pitfalls in diagnosis and the overlap of symptoms with other conditions like NNH. Specialized centers with expertise in CS diagnosis and differential testing are recommended for accurate evaluation and management of these patients.

Change point detection in high dimensional covariance matrix using Pillai’s statistics

AbstractThis research proposes a method to test and estimate change points in the covariance structure of high-dimensional multivariate series data. Our method uses the trace of the beta matrix, known as Pillai’s statistics, to test the change in covariance matrix at each time point. We study the asymptotic normality of Pillai’s statistics for testing the equality of two covariance matrices when both sample size and dimension increase at the same rate. We test the existence of a single change point in a given time period using Cauchy combination test, the test using an weighted sum of Cauchy transformed p-values, and estimate the change point as the point whose statistic is the greatest. To test and estimate multiple change points, we use the idea of the wild binary segmentation and repeatedly apply the procedure for a single change point to each segmented period until no significant change point exists. We numerically provide the size and power of our method. We finally apply our procedure to finding abnormal behavior in the investment of a private equity fund.

PEPITA: Parallelized High-Throughput Quantification of Ototoxicity and Otoprotection in Zebrafish Larvae.

Drug-induced hearing injury (ototoxicity) is a common, debilitating side effect of many antibiotic regimens that can be worsened by adverse drug interactions. Such adverse drug interactions are often not detected until after drugs are already on the market because of the difficulty of measuring all possible drug combinations. While in vivo mammalian assays to screen for ototoxic damage exist, they are currently time-consuming, costly, and limited in throughput, which limits their utility in assessing drug interaction outcomes. To facilitate more rapid quantification of ototoxicity and assessment of adverse drug interactions that impact ototoxicity, we have developed a high-throughput workflow we call parallelized evaluation of protection and injury for toxicity assessment (PEPITA). PEPITA uses zebrafish larvae to quantify ototoxic damage and protection. Previous work has shown that hair cells (HCs) in the zebrafish lateral line are very similar to human inner ear HCs, meaning zebrafish are a viable model to test drug-induced ototoxicity. In PEPITA, we expose zebrafish larvae to different combinations of drugs, fluorescently label the HCs, and subsequently use microscopy to quantify the brightness of the fluorescently labeled HCs as an assay for ototoxic damage and hair-cell viability. PEPITA is a reproducible, low-cost, technically accessible, and high-throughput assay. These advantages allow many experiments to be conducted in parallel, paving the way for systematic evaluation of drug-induced hearing injury and other multidrug interactions. Key features • Analysis of drug-induced hair cell damage associated with ototoxicity using Danio rerio • Ototoxicity assessment performed in vivo • Uses microscopy to generate images to assay ototoxicity quantitatively. • Enables testing of various combinations of drugs at various doses to determine toxicity-associated drug-drug interaction outcomes (synergy, antagonism).

Low PAPPA and Its Association with Adverse Pregnancy Outcomes in Twin Pregnancies: A Systematic Review of the Literature and Meta-Analysis

Background: It is well established in the literature that pregnancy-associated plasma protein-A (PAPP-A) is linked to several adverse pregnancy outcomes, including pre-eclampsia (PE), fetal growth restriction (FGR), and preterm birth (PTB) in singleton pregnancies. However, data regarding such an association in twin pregnancies are lacking. The primary goal of this systematic review and meta-analysis was to assess the potential value of low PAPP-A levels in the prediction of the subsequent development of hypertensive disorders of pregnancy (HDPs), PTB, and small for gestational age (SGA)/FGR fetuses in twin pregnancies and investigate its association with the development of gestational diabetes, intrauterine death (IUD) of at least one twin, and birth weight discordance (BWD) among the fetuses. Methods: Medline, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar databases were systematically searched from inception until 31 July 2024. All observational studies reporting low PAPP-A levels after the performance of the first-trimester combined test as part of the screening for chromosomal abnormalities with reported adverse pregnancy outcomes were included. Results: The current systematic review encompassed a total of 11 studies (among which 6 were included in the current meta-analysis) that enrolled a total of 3741 patients. Low PAPP-A levels were not associated with HDPs (OR 1.25, 95% CI 0.78, 2.02, I-square test: 13%). Low PAPP-A levels were positively associated with both the development of preterm birth prior to 32 (OR 2.85, 95% CI 1.70, 4.77, I-square test: 0%) and 34 weeks of gestational age (OR 2.09, 95% CI 1.34, 3.28, I-square test: 0%). Furthermore, low PAPP-A levels were positively associated with SGA/FGR (OR 1.58, 95% CI 1.04, 2.41, I-square test: 0%). Prediction intervals indicated that the sample size that was used did not suffice to support these findings in future studies. Conclusions: Our study indicated that low PAPP-A levels are correlated with an increased incidence of adverse perinatal outcomes in twin pregnancies. Identifying women at elevated risk for such adversities in twin pregnancies may facilitate appropriate management and potential interventions, but additional studies are required to identify the underlying mechanism linking PAPP-A with those obstetrical complications.

Study on artificial intelligence recognition pre-processing algorithm for cervical cancer

INTRODUCTION: Cervical cancer is the most common malignant tumor in the female reproductive system, with the number of deaths due to cervical cancer in developing countries accounting for 80% of the global total. In China, the incidence rate of cervical cancer is increasing year by year. At present, the commonly used methods for cervical cancer screening include TCT, HPV testing, TCT+HPV combined testing, FRD, and VIA/VILI. Among them, although TCT+HPV combined testing has high sensitivity and specificity, it is costly and time-consuming. VIA/VILI screening is cost-effective, easy to operate, and suitable for promotion in economically underdeveloped areas.However, VIA/VILI screening relies on the subjective judgment of doctors, so its accuracy is relatively low in rural areas of China with a large population and a lack of well-trained doctors. To address this issue, computer-aided diagnosis (CAD) technology is needed to improve the accuracy and reliability of VIA/VILI screening. OBJECTIVES: The implementation of artificial intelligence (AI)-based Visual Inspection with Acetic acid (VIA) screening and computer-aided diagnosis has the potential to significantly reduce the cost of cervical cancer screenings and increase the coverage rate of cervical cancer screenings, thus reducing the incidence rate of the disease. To this end, we have developed an AI preprocessing algorithm aimed at improving the accuracy of AI in detecting cervical cancer. METHODS: Initially, the algorithm maps images to the YCrCb and Lab color spaces. Unlike traditional enhancement methods that mainly focus on the luminance channel, our method primarily enhances the Cr channel in the YCrCb color space and a channel in the Lab color space. This paper innovatively proposes the LT_CLAHE algorithm to enhance the Cr channel, obtaining an enhanced image with a bias towards blue-green colors, and uses the WLS algorithm to enhance the a channel, obtaining an enhanced image with a bias towards red colors. Subsequently, the enhanced images from both color spaces are fused to eliminate color distortion. RESULTS: Experimental results show that our method significantly enhances the texture of lesions and outperforms traditional methods across various objective indicators. When the enhanced images from this paper are used as input for neural networks, there is also a significant increase in the accuracy of neural network detection.

Unsupervised representation learning of Kohn–Sham states and consequences for downstream predictions of many-body effects

Representation learning for the electronic structure problem is a major challenge of machine learning in computational condensed matter and materials physics. Within quantum mechanical first principles approaches, density functional theory (DFT) is the preeminent tool for understanding electronic structure, and the high-dimensional DFT wavefunctions serve as building blocks for downstream calculations of correlated many-body excitations and related physical observables. Here, we use variational autoencoders (VAE) for the unsupervised learning of DFT wavefunctions and show that these wavefunctions lie in a low-dimensional manifold within latent space. Our model autonomously determines the optimal representation of the electronic structure, avoiding limitations due to manual feature engineering. To demonstrate the utility of the latent space representation of the DFT wavefunction, we use it for the supervised training of neural networks (NN) for downstream prediction of quasiparticle bandstructures within the GW formalism. The GW prediction achieves a low error of 0.11 eV for a combined test set of two-dimensional metals and semiconductors, suggesting that the latent space representation captures key physical information from the original data. Finally, we explore the generative ability and interpretability of the VAE representation.

Clinical significance of peripheral blood DDR1 and CtBP gene methylation detection in patients with acute pancreatitis

ABSTRACT To investigate the clinical value of methylation levels of peripheral blood DDR1 and CtBP genes in evaluating the severity of acute pancreatitis (AP). Collect 90 blood samples from AP patients and healthy volunteers, and test methylation levels of SPINK1, STAT3, KIT, CFTR, DDR1, CtBP1, CtBP2 genes by bisulfite amplicon sequencing (BSAS). The gene methylation and clinical predictors of SAP early prediction were determined by univariate and multifactorial analysis, respectively. (1) The methylation level of CtBP1 gene and MCTSI score were independent predictors of SAP, with AUC values of 0.723 and 0.8895, respectively. (2) The methylation levels of DDR1, CtBP2, CFTR and SPINK1 genes were statistically significant in HC group vs AP group, HC group vs MAP group, and HC group vs SAP group. (3) The combined detection of CtBP1 gene methylation level and MCTSI score predicted the sensitivity, specificity, AUC, and 95%CI of SAP were 0.750, 0.957, 0.902, and 0.816–0.989, respectively. (1) The methylation level of CtBP1 gene in peripheral blood is an independent risk factor for predicting SAP and is a potentially good predictor of SAP, and the combined testing with the MCTSI score does not further significantly improve the early predictive value for SAP. (2) The methylation levels of DDR1, SPINK1, CtBP2, and CFTR genes were potential indicators for recognizing AP.

Epidemiology and laboratory testing of Brucella spondylitis

The average age of patients with BS was 52.29 ± 9.46 years, comprising 136 males and 31 females. Risk factors for BS include close contact with cattle and sheep and consumption of unpasteurized food. The positive detection rate using combined Rose Bengal Test (RBT) and Standard Agglutination Test (SAT) was 94.6%, whereas the positive rate for blood culture was only 7.8%. The most common clinical manifestations were fever (81.4%), back pain (88.6%), sweating (61.1%), fatigue (69.5%), and anorexia (65.3%). Hematological examinations often revealed decreased hemoglobin (18.0%), increased platelets (18.0%), elevated erythrocyte sedimentation rate (ESR) (88.0%), elevated C-reactive protein (CRP) (78.4%), elevated Alanine aminotransferase (ALT) (18.6%), and decreased K+(23.4%). The imaging examinations revealed that the lumbar spine, particularly L4/5 (41.3%), is the most frequently affected vertebral level in BS. After treatment, the overall recurrence rate was 3.0%. In endemic areas, clinicians should be vigilant for BS in patients presenting with back pain and unexplained fever, particularly those with a history of close contact with cattle and sheep. The RBT and SAT tests show a high positivity rate of 94.6%, establishing them as the preferred diagnostic methods. This study enhances clinicians’ comprehension of BS characteristics and lays a robust theoretical groundwork for disease prevention and monitoring.

Multi-species cryoEM calibration and workflow verification standard.

Cryogenic electron microscopy (cryoEM) is a rapidly growing structural biology modality that has been successful in revealing molecular details of biological systems. However, unlike established biophysical and analytical techniques with calibration standards, cryoEM has lacked comprehensive biological test samples. Here, a cryoEM calibration sample consisting of a mixture of compatible macromolecules is introduced that can not only be used for resolution optimization, but also provides multiple reference points for evaluating instrument performance, data quality and image-processing workflows in a single experiment. This combined test specimen provides researchers with a reference point for validating their cryoEM pipeline, benchmarking their methodologies and testing new algorithms.

Research on safety control technology of high-speed railway combined test based on threatening event analysis

PurposeSafety management is a key point and poses a challenge in joint testing. To detect and address potential accidents' hidden dangers early, this paper conducts research on the safety control technology for high-speed railway joint tests by incorporating the concept of hazardous events.Design/methodology/approachAiming at ensuring the safety of high-speed railway combined inspections and trials, this paper starts from the dual prevention mechanism. It introduces the concept of threatening events, defines them and analyzes the differences between threatening events and railway accidents. The paper also proposes a cause model for threatening events in high-speed railway combined inspections and trials, based on three types of hazard sources. Furthermore, it conducts research on the control strategies for these threatening events.FindingsThe research on safety control technology for high-speed railway combined operation and testing, based on the analysis of threatened events, offers a new perspective for safety management in these operations. It also provides theoretical and practical support for the transition from passive prevention to active risk pre-control, which holds significant theoretical and practical value.Originality/valueThe innovation mainly includes the following three aspects: (1) Building on the traditional dual prevention mechanism, which includes risk hierarchical management and control as well as hidden danger investigation and management, a triple prevention mechanism is proposed. This new mechanism adds the management of threatening events as the third line of defense. The aim is to more comprehensively identify and address potential security risks, thereby enhancing the efficiency and effectiveness of security management. (2) In this paper, the definition of a railway threatening event is clarified, and the causative model of a high-speed railway threatening event based on three kinds of danger sources is proposed. (3) This paper puts forward the control strategy of the high-speed railway combined operation and trial, which includes five key links: identification, reporting, analysis, rectification and feedback, which provides a new perspective for the safety management of the high-speed railway combined operation and trial and has important theoretical and application value.

Lesion Characterization by 99mTc-MIBI Myocardial Perfusion Imaging (MPI) &amp; 18F-FDG Cardiac PET Following Myocardial Infarction Before Revascularization &amp; Outcome Prediction: Initial Experience in Bangladesh

99mTc-MIBI SPECT myocardial perfusion imaging (MPI) and 18F-FDG cardiac positron emission tomography (Cardiac PET) can assess the extent and severity of myocardial perfusion and metabolic defect following myocardial infarction (MI) and also able to predict the outcome before revascularization in known coronary artery disease patients. About 135 cases of known coronary artery disease patients were enrolled here for combined nuclear imaging tests, rest only ECG gated MPI and FDG cardiac PET to assess myocardial perfusion and viability status following MI prior to revascularization. In this study we want to figure out the utility of this combined protocol for myocardial lesion characterization and its role for clinical decision-making in-patient selection prior to revascularization and treatment planning. We are also intended to share the initial outcome in available follow up cases. J Inv Clin Cardiol 2023; 5(2): 45-52

Improving exercise cardiac reserve assessment using a novel cardiopulmonary and echocardiography testing protocol (CPET-ESE) based on individualised exercise intensity domains

Abstract Background Functional exercise stress echocardiography (ESE) is used to quantify changes in cardiac reserve and can improve early cardiac dysfunction diagnosis and follow-up.[1.2] Current ESE protocols do not account for individual variations in fitness and heart rate response, leading to difficulties in defining normal reference values.[2,3] Physiologically defined exercise intensity domains could be implemented as part of combined cardiopulmonary and ESE testing (CPET-ESE) to address this problem. Purpose We propose that using exercise intensity domains as part of CPET-ESE will result in cardiac reserve values not influenced by individual cardiorespiratory fitness or physical activity (PA) levels. We also hypothesise by matching work-rates and heart rates (HR), respectively, cardiac reserve will be higher in those exercising at the higher exercise intensity domain. Methods A total of 45 healthy adults (mean age 43.8 ± 14.2, range 18-65 y) underwent a CPET followed by a CPET-ESE consisting of two 6-minute stages: 1. Moderate intensity (MOD) at 90% of the work-rate at the gas exchange threshold (GET) and 2. High intensity (HIGH) at 40% of the difference between GET and peak. Global left ventricular and right ventricular free wall (LV and RV) longitudinal strain (Sl), RV fractional area change (RV-FAC), peak LV and RV TDI derived systolic (S’) and diastolic velocities (E’) were measured at each step, including rest. HIGH steps were matched 1-to-n with MOD steps from other participants based on work-rate and HR, respectively. Questionnaire derived PA was classified as low, moderate, and high active. Cardiorespiratory fitness was measured as peak oxygen uptake relative to body mass (mL·kg-1·min-1). Results After adjusting for age and sex, neither higher PA nor peak VO2 were associated with higher cardiac function parameters at either intensity (Table 1). Higher peak VO2 was associated with higher work-rate for HIGH only, while higher PA was associated with lower HR for MOD only (interaction term p&amp;lt;0.05). When paired by matching HR and work-rate, respectively, HIGH was associated with higher cardiac function parameters compared to MOD (all except for LV-S’ and RV-FAC when HR matched, Table 2), despite those matched from HIGH being older, less physically active and having lower peak VO2 (p&amp;lt;0.05 for all). Conclusions Current ESE protocols, which define submaximal exercise intensity using arbitrary work-rate or HR targets,[3] do not account for the complex differences in exercise response between healthy individuals. Cardiac function augmentation during exercise is likely a response to VO2 kinetics and this is not accurately described by either HR or work-rate alone. We derived normal reference values for cardiac reserve from implementing physiologically defined exercise intensity domains within the combined CPET-ESE testing frameworks. These values could be more appropriately used when comparing diverse clinical populations using CPET-ESE.

Detection of hypotension in patients with syncope: combined tilt test and ambulatory blood pressure monitoring strategy in clinical practice

Abstract Both ambulatory blood pressure monitoring (ABPM) and Tilt Test (TT) (a provocation method), can identify the hypotensive component that predisposes to syncope. Objective 1)To establish a) the prevalence of confirmed hypotension (CHp) with both methods; b) the concordance between them. Methods Patients (pts) ≥18 years with syncope for whom it was decided to perform a TT were included. TT was performed for 45 min at 75 degrees. On a different day, within 15 days, an ABPM was performed (≥70 % adequate readings). Criteria: CHp: In TT: TT(+) or detection of systolic blood pressure (SBP) ≤ 100 mmHg during the study resulting from a drop from baseline; in ABPM: SBP ≤ 100 mmHg resulting from a drop ≥ 20 mmHg from the previous one. Only the awake periods were considered. Results 61 pts (age= 62.5±16.8, female= 39 (64%); antihypertensive medications= 35 pts (57%); Cardiovascular history, except isolated hypertension= 29 pts (47%). The reported number of episodes was 4±4.4 (median=2). Syncope was post-prandial in 25 pts (41%) and probable reflex by the description in 28 pts (46%). CHp during syncope was confirmed in 25 pts during TT and in 1 pt during ABPM. Positive responses to TT were: vasodepressor in 14 pts, mixed in 10 pts and disautonomic pattern in 1 pt. Average 24 h in ABPM was above 135 mmHg in 10 pts (16%). Seventy-nine per cent of the population (48 pts) presented ≥ 2 falls ≥20 mmHg of SBP during the waking period. SBP ≤ 100 mmHg constituted ≥ 20% of awake measurements in 10 pts (16%). A post-prandial fall in SBT ≥ 20 mmHg was detected in 24 patients (39%). Of these, in 8 (13%), the achieved SBP was ≤ 100 mmHg. Table 1 shows the prevalence for CHp with both methods. Table 2 shows the concordance between TT and ABPM. CHp was detected by TT or ABPM in 48 pts, i.e 79% of the population. Both studies were concordant in 32 pts (52%) (Cohen's kappa coefficient: 0.04). CHp was identified in 28% of pts only by TT and in 20% only by ABPM. Conclusion CHp was detected in ¾ of this population using a combined TT and ABPM strategy. They were complementary not only to establish a diagnostic suspicion, but also to guide the therapeutic management of these patients.CHp PrevalenceTT and ABPM Concordance

The impact of left venticular filling pressure indexed to cardiac output on exercise capacity in heart failure subjects

Abstract Background/Introduction Exercise intolerance is the most common symptom of patients with heart failure (HF), regardless of the phenotypes. We aim to investigate the determinants of exercise capacity in chronic stable HF with reduced, mildly reduced, preserved, and recovered ejection fraction (EF). Methods Ambulatory HF subjects were recruited for a combined cardiopulmonary exercise test and exercise stress echocardiography. Peak oxygen consumption (peak VO2) and minute ventilation-carbon dioxide production relationship (VE/VCO2 slope) were obtained. Impaired exercise capacity was referred to a peak VO2 of &amp;lt;14 ml/kg/min, and a VE/VCO2 slope of &amp;gt;34 was defined as ventilatory inefficiency. Results Among a total of 66 participants, there were 16 HF with reduced EF, 18 HF with mildly reduced EF, 12 HF preserved EF, and 20 HF recovered EF. While both LVEF, global longitudinal strain (GLS), E/e’ ratio and diastolic dysfunction indices were crudely associated with peak VO2 and VE/VCO2 slope, only diastolic dysfunction indices were independently predictive of impaired exercise capacity (odds ratio and 95% confidence intervals: 3.847, 1.369-10.810). GLS at rest was independently correlated with ventilatory inefficiency (1.404, 1.050-1.877). Among the exercise indices, the peak medial E/e' to cardiac output ratio was independently associated with impaired exercise capacity (3.478, 1.313-9.214) and peak GLS was best related to ventilatory inefficiency (1.403, 1.076-1.828). Conclusions Among resting and exertional echocardiographic variables, the peak medial E/e' to cardiac output ratio, a non-invasive assessment of exertional left ventricular filling pressure indexed to cardiac output, was the major determinant of exercise capacity in patients with different HF phenotypes.

Otolith assessment in elderly using combined vestibular-evoked myogenic potentials and subjective visual vertical test

BackgroundDizziness in elderly patients is classified as a multifactorial geriatric syndrome leading to pathological conditions or changes endemic to the aging process, it is characterized by increased susceptibility to accidents and instability. This is considered a major public health problem. In our study, we assessed age related changes in vestibular function via measurement of combined Vestibular-Evoked Myogenic potentials (VEMPs) as well as Static Subjective Visual Vertical Test (SVVT) for otolith function.MethodsSeventy-five subjects (150 ears) were enrolled in this research. They were categorized into a control group composed of twenty-five adults from 18–40 years and a study group which divided into symptomatic and asymptomatic groups, each group consisted of twenty-five subjects, fifteen subjects aged 55- < 65 years & ten subjects aged 65 to 85 years. All subjects were submitted to combined VEMPs and static SVVT.ResultsDetectability of combined VEMPs decreased with age with significant difference among the older age group (> 65- < 85 years) and the subjects aged (55- < 65 years). Percentage of abnormal cVEMPs & oVEMPs latencies and amplitudes was more detected in the older age group than subjects aged (55- < 65 years). The symptomatic group aged > 65 years showed higher percentage of affection of both cVEMPs & oVEMPs, while the younger group aged 55- < 65 showed higher absence of bilateral oVEMPs. There were no statistically significant differences in the asymmetrical ratio of cVEMPs & oVEMPs between elderly and adults. Static SVV perception does not change with age.ConclusionsThe elderly showed variable degrees of otolith dysfunction with a high percentage of affection in cVEMPs and oVEMPs. Also, they showed symptoms of imbalance and light-headedness. Static SVVT perception doesn’t change with age.

Comparing combined testing of cMyBP-C and hs-cTnT with other algorithms for rapid rule-out of acute myocardial infarction in suspected acute coronary syndrome patients

Abstract Background We aimed to compare the diagnostic accuracy of a dual-marker strategy (DMS), incorporating cardiac myosin-binding protein C (cMyBP-C) and high-sensitivity cardiac troponin T (hs-cTnT) testing, against other rapid rule-out algorithms for acute myocardial infarction (AMI). Methods We enrolled 2059 patients presenting to the emergency department with suspected AMI and compared diagnostic measures using the DMS (cMyBP-C &amp;lt;10 ng/L and hs-cTnT≤14 ng/L), serial hs-cTnT sampling (hs-cTnT&amp;lt;14ng/L at different time points within 1-3h), modified European Society of Cardiology (ESC) 0/1h- or 0/3h-protocol (hs-cTnT&amp;lt;5ng/L or &amp;lt;12ng/L &amp; ∆hs-cTnT&amp;lt;3ng/L at 1h or &amp;lt;7ng/L at 3h if hs-cTnT at 1h was not available), as well as the hs-cTnT limit-of-blank (LoB, &amp;lt;3ng/L) and -detection (LoD, &amp;lt;5ng/L) were compared. Negative predictive values (NPV) and sensitivities for AMI rule-out were assessed. Results True-negative rule-out rates using the DMS ranged from 38.1% to 51.6% across all patients, surpassing rates of 6.2%, 17.4%, 45%, and 50.8% achieved by LoB, LoD, serial hs-cTnT sampling, and ESC 0/1h or 0/3h algorithms, respectively. The DMS demonstrated an NPV of 99.7%, similar to serial hs-cTnT sampling and ESC 0/1h or 0/3h algorithms, and 100% for both LoB and LoD. Sensitivities were 98.9%, 98.9%, 100%, and 100%, respectively. Conclusions The DMS - incorporating cMyBP-C and hs-cTnT - effectively rules out AMI, showing non-inferiority to hs-cTnT-only-based rapid rule-out algorithms and offers a promising alternative, potentially enhancing clinical decision-making in emergency settings.

Analysis of Fracture Modes and Acoustic Emission Characteristics of Low‐Frequency Disturbed Water‐Bearing Soft Rock With Different Cyclic Initial Value

ABSTRACTIn the complex geological environment of deep mining area, water‐bearing soft rock is more prone to damage and destruction by low‐frequency disturbance. In this paper, the dynamic–static combination test was conducted on the basis of uniaxial compression test by using creep dynamic disturbance impact loading system and acoustic emission technique. The test results show that with the increase of the initial value of disturbance loading, the fracture morphology of sandstone gradually changes from a single major crack to multiple cracks coexisting, and some saturated sandstones lose the bearing capacity in the process of disturbance, presenting a cone‐shaped fracture surface. The increase of the initial value of the disturbance changes the bearing capacity of the sandstone, and the peak energy of acoustic emission reaches the maximum value when the initial value of the disturbance is 80% UCS. The results of the study can provide some reference for the stability analysis of deep water‐rich soft rock mines.

AKTIVITAS ANTITUMOR KOMBINASIEKSTRAKTyphonium flagelliformeDENGANINTERFERON ALAMIANJING DAN KUCING PADA MENCITDENGAN TUMORKULIT YANG DIINDUKSIDMBA

Indonesia has various plants with potential activities and uses as antitumor agents, one of which is Typhonium flagelliforme. This study aimed to examine in vivo the effects of combination therapy of T. flagelliforme leaf-ethanolic extract and natural interferon of canine or feline as an antitumor agent. In this study, 18 female mice of ddY strain induced with 7.12-dimethyl-benz(?)anthracene (DMBA) carcinogenic substance were divided into six treatment groups. All tumor tissues formed were collected and made for histopathological slides. The slides were stained with Hematoxylin-Eosin (HE) and immunohistochemistry (IHC) procedure using antibodies for proliferating cell nuclear antigen (PCNA) and Caspase-3. The macroscopic observations showed that the skin surface of the mice groups with tumors had alopecia with a reddish color. The microscopic observations showed three tumors types: anaplastic carcinoma, fibrosarcoma, and squamous cell carcinoma. The mitotic, angiogenesis, PCNA and Caspase-3 tests showed significant differences among the groups administered with the single and combination test materials. The combination therapy of T. flagelliforme leaf-ethanolic extract and natural interferon can stabilize mice’s body weight, inhibit tumor growth, reduce mitosis and angiogenesis, and reduce PCNA and Caspase-3 expression.