Difference In Time Research Articles

A collaborative multidisciplinary trauma program improvement team improves VTE chemoprophylaxis guideline compliance in non-operative stable TBI.

Delays in initiating venous thromboembolism (VTE) prophylaxis in patients suffering from traumatic brain injury (TBI) persist despite guidelines recommending early initiation. We hypothesized that the expansion of a Trauma Program Performance Improvement (PI) team will improve compliance of early (24-48 hours) initiation of VTE prophylaxis and will decrease VTE events in TBI patients. We performed a single-center retrospective review of all TBI patients admitted to a Level I trauma center before (2015-2016,) and after (2019-2020,) the expansion of the Trauma Performance Improvement and Patient Safety (PIPS) team and the creation of trauma process and outcome dashboards. Exclusion criteria included discharge or death within 48 hours of admission, expanding intracranial hemorrhage on CT scan, and a neurosurgical intervention (craniotomy, pressure monitor, or drains) prior to chemoprophylaxis initiation. A total of 1,112 patients met the inclusion criteria, of which 54% (n = 604) were admitted after Trauma PIPS expansion. Following the addition of a dedicated PIPS nurse in the trauma program and creation of process dashboards, the time from stable CT to VTE prophylaxis initiation decreased (52 hours to 35 hours; p < 0.001) and more patients received chemoprophylaxis at 24 hours to 48 hours (59% from 36%, p < 0.001) after stable head CT. There was no significant difference in time from first head CT to stable CT (9 vs. 9 hours; p = 0.15). The Contemporary group had a lower rate of VTE events (1% vs. 4%; p < 0.001) with no increase in bleeding events (2% vs. 2%; p = 0.97). On multivariable analysis, being in the Early cohort was an independent predictor of VTE events (adjusted odds ratio, 3.74; 95% confidence interval, 1.45-6.16). A collaborative multidisciplinary Trauma PIPS team improves guideline compliance. Initiation of VTE chemoprophylaxis within 24 hours to 48 hours of stable head CT is safe and effective. Therapeutic/Care Management; Level IV.

Gabapentin and Rapidity of Recovery Among Patients Undergoing Minimally Invasive Ambulatory Uro-Oncologic Surgeries.

Gabapentin has been used in enhanced recovery after surgery (ERAS) pathways for pain control for patients undergoing ambulatory uro-oncologic surgery; however, it may cause undesirable side effects. We studied the causal association between gabapentin and rapidity of recovery and perioperative pain management after minimally invasive uro-oncologic surgery. We identified 2397 patients ≤ 65 years undergoing prostatectomies or nephrectomies between 2018 and 2022; 131 (5.5%) did not receive gabapentin. We tested the effect of gabapentin use on time of discharge and perioperative opioid consumption, respectively, using multivariable linear regression adjusting for potential confounders including age, gender, BMI, American Society of Anesthesiologists score, and surgery type. On adjusted analysis, we found no evidence of a difference in discharge time among those who did vs did not receive gabapentin (adjusted difference 0.07 hours shorter on gabapentin; 95% CI -0.17, 0.31; P = .6). There was no evidence of a difference in intraoperative opioid consumption by gabapentin receipt (adjusted difference -1.5 morphine milligram equivalents; 95% CI -4.2, 1.1; P = .3) or probability of being in the top quartile of postoperative opioid consumption within 24 hours (adjusted difference 4.2%; 95% CI -4.8%, 13%; P = .4). We saw no important differences in confounders by gabapentin receipt suggesting causal conclusions are justified. Our confidence intervals did not include clinically meaningful benefits from gabapentin, when used with an ERAS protocol, in terms of length of stay or perioperative opioid use. These results support the omission of gabapentin from ERAS protocols for minimally invasive uro-oncologic surgeries.

Cross-correlation adjustment full-waveform inversion with source encoding in ultrasound computed tomography

Full-waveform inversion (FWI) is one of the leading-edge techniques in ultrasound computed tomography (USCT). FWI reconstructs the images of sound speed by iteratively minimizing the difference between the predicted and measured signals. The challenges of FWI are to improve its stability and reduce its computational cost. In this paper, a new USCT algorithm based on cross-correlation adjustment FWI with source encoding (CCAFWI-SE) is proposed. In this algorithm, the gradient is adjusted using the intermediate signals as the inversion target rather than the measured signals during iteration. The intermediate signals are generated using the travel time difference calculated by cross-correlation. In the case of conventional FWI failure, using the proposed algorithm, the estimated sound speed can converge toward the ground truth. To reduce the computational cost, an intermittent update strategy is implemented. This strategy only requires one time for the calculation of the travel time difference per stage, so that the source encoding can be used. Simulation and laboratory experiments are implemented to validate this approach. The experiment results show it has successfully recovered the sound speed model, while conventional FWI failed when the initial model greatly differed from the ground truth. This verifies that our approach improves the stability of the reconstruction in USCT. In practice, additional computational costs can be reduced by combining our approach with existing methods. The proposed approach increases the robustness of the FWI and expands its application.

Determining the time before or after a galaxy merger event

Aims. This work aims to reproduce the time before or after a merger event of merging galaxies from the IllustrisTNG cosmological simulation using machine learning. Methods. Images of merging galaxies were created in the u, g, r, and i bands from IllustrisTNG. The merger times were determined using the time difference between the last simulation snapshot where the merging galaxies were tracked as two galaxies and the first snapshot where the merging galaxies were tracked as a single galaxy. This time was then further refined using simple gravity simulations. These data were then used to train a residual network (ResNet50), a Swin Transformer (Swin), a convolutional neural network (CNN), and an autoencoder (using a single latent neuron) to reproduce the merger time. The full latent space of the autoencoder was also studied to see if it reproduces the merger time better than the other methods. This was done by reducing the latent space dimensions using Isomap, linear discriminant analysis (LDA), neighbourhood components analysis, sparse random projection, truncated singular value decomposition, and uniform manifold approximation and projection. Results. The CNN is the best of all the neural networks. The performance of the autoencoder was close to the CNN, with Swin close behind the autoencoder. ResNet50 performed the worst. The LDA dimensionality reduction performed the best of the six methods used. The exploration of the full latent space produced worse results than the single latent neuron of the autoencoder. For the test data set, we found a median error of 190 Myr, comparable to the time separation between snapshots in IllustrisTNG. Galaxies more than ≈625 Myr before a merger have poorly recovered merger times, as well as galaxies more than ≈125 Myr after a merger event.

Effects of tramadol hydrochloride preemptive analgesia in kyphoplasty of thoracolumbar osteoporotic fractures under local anesthesia

To explore preemptive analgesic effect of preoperative intramural tramadol injection in percutaneous kyphoplasty (PKP) of vertebrae following local anesthesia. From August 2019 to June 2021, 118 patients with thoraco lumbar osteoporotic fractures were treated and divided into observation group and control group, with 59 patients in each gruop. In observation group, there were 26 males and 33 females, aged from 57 to 80 years old with an average of (67.69±4.75)years old;14 patients on T11, 12 patients on T12, 18 patients on L1, 15 patients on L2;tramadol with 100 mg was injected intramuscularly half an hour before surgery in observation group. In control group, there were 24 males and 35 females, aged from 55 to 77 years old with an average of (68.00±4.43) years old;19 patients on T11, 11 patients on T12, 17patients on L1, 12 patients on L2;the same amount of normal saline was injected intramuscularly in control group. Observation indicators included operation time, intraoperative bleeding, visual analogue scale (VAS) evaluation and recording of preoperative (T0), intraoperative puncture(T1), and working cannula placement (T2) between two groups of patients, at the time of balloon dilation (T3), when the bone cement was injected into the vertebral body (T4), 2 hours after the operation (T5), and the pain degree at the time of discharge(T6);adverse reactions such as dizziness, nausea and vomiting were observed and recorded;the record the patient's acceptance of repeat PKP surgery. All patients were successfully completed PKP via bilateral pedicle approach, and no intravenous sedative and analgesic drugs were used during the operation. There was no significant difference in preoperative general data and VAS(T0) between two groups (P>0.05). There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). VAS of T1, T2, T3, T4 and T5 in observation group were all lower than those in control group(P<0.05), and there was no significant difference in T6 VAS (P>0.05). T6 VAS between two groups were significantly lower than those of T0, and the difference was statistically significant (P<0.05). There was no significant difference in incidence of total adverse reactions between two groups (P>0.05). There was a statistically significant difference in the acceptance of repeat PKP surgery (P<0.05). Half an hour before operation, intramuscular injection of tramadol has a clear preemptive analgesic effect for PKP of single-segment thoracolumbar osteoporotic fracture vertebral body under local anesthesia, which could increase the comfort of patients during operation and 2 hours after operation, and improve patients satisfaction with surgery.

Human–Robot Collaboration on a Disassembly-Line Balancing Problem with an Advanced Multiobjective Discrete Bees Algorithm

As resources become increasingly scarce and environmental demands grow, the recycling of products at the end of their lifecycle becomes crucial. Disassembly, as a key stage in the recycling process, plays a decisive role in the sustainability of the entire operation. Advances in automation technology and the integration of Industry 5.0 principles make the balance of human–robot collaborative disassembly lines an important research topic. This study uses disassembly-precedence graphs to clarify disassembly-task information and converts it into a task-precedence matrix. This matrix includes both symmetry and asymmetry, reflecting the dependencies and independencies among disassembly tasks. Based on this, we develop a multiobjective optimisation model that integrates disassembly-task allocation, operation mode selection, and the use of collaborative robots. The objectives are to minimise the number of workstations, the idle rate of the disassembly line, and the energy consumption. Given the asymmetry in disassembly-task attributes, such as the time differences required for disassembling various components and the diverse operation modes, this study employs an evolutionary algorithm to address potential asymmetric optimisation problems. Specifically, we introduce an advanced multi-objective discrete bee algorithm and validate its effectiveness and superiority for solving the disassembly-line balancing problem through a comparative analysis with other algorithms. This research not only provides innovative optimisation strategies for the product-recycling field but also offers valuable experience and reference for the further development of industrial automation and human–robot collaboration.

The impact of antifibrotic use on long-term clinical outcomes in the pulmonary fibrosis foundation registry

BackgroundIdiopathic pulmonary fibrosis (IPF) is a devastating interstitial lung disease (ILD) with a high mortality rate. The antifibrotic medications pirfenidone and nintedanib have been in use since 2014 for this disorder and are associated with improved rate of lung function decline. Less is known about their long-term outcomes outside of the clinical trial context.MethodsThe Pulmonary Fibrosis Foundation Patient Registry was used for this study. Patients with an IPF diagnosis made within a year of enrollment were included. The treated group was defined as patients receiving either pirfenidone or nintedanib for at least 180 days. The untreated group did not have any record of antifibrotic use. Demographic data, comorbidities, serial lung function, hospitalization, and vital status data were collected from the registry database. The primary outcomes were transplant-free survival, time to first respiratory hospitalization, and time to 10% absolute FVC decline. Time-to-event analyses were performed utilizing Cox proportional hazards models and the log-rank test. Model covariates included age, gender, smoking history, baseline lung function, comorbidities, and oxygen use.ResultsThe registry contained 1212 patients with IPF; ultimately 288 patients met inclusion criteria for the treated group, and 101 patients were designated as untreated. Patients treated with antifibrotics were significantly younger (69.8 vs. 72.6 years, p = 0.008) and less likely to have smoked (61.1% ever smokers vs. 72.3% never smokers, p = 0.04). No significant differences were seen in race, gender, comorbidities, or baseline pulmonary function between groups. The primary outcome of transplant-free survival was not significantly different between the two groups (adjusted HR 0.799, 95% CI 0.534–1.197, p = 0.28). Time to respiratory hospitalization was significantly shorter in the treated group (adjusted HR 2.12, 95% CI 1.05–4.30, p = 0.04). No significant difference in time to pulmonary function decline was seen between groups.ConclusionsThis multicenter study demonstrated 63% of newly diagnosed IPF patients had continuous antifibrotic usage. Antifibrotics were not associated with improved transplant-free survival or pulmonary function change but was associated with an increased hazard of respiratory hospitalization. Future studies should further investigate the role of antifibrotic therapy in clinically important outcomes in real-world patients with IPF and other progressive ILDs.

Shrinking the 13D disclosure window will benefit non-activist investors

Purpose This study aims to examine the Securities and Exchange Commission’s final rule in Modernization of Beneficial Ownership Reporting, which reduced the time for significant public company shareholders to file Schedule 13D (effective February 5, 2024). The authors corroborate prior results under the historic 10-day maximum reporting regime and provide updated academic analysis regarding how the five-day deadline between the “triggering” event, accumulating 5% of the outstanding shares and public disclosure of that event will affect abnormal returns. Design/methodology/approach This empirical archival study uses publicly available data. Findings The analyses show that changing from a 10-day to a 5-day Schedule 13 disclosure window will reduce activist investors’ opportunity to profit by legally delaying the filing of Schedule 13D. These excess returns for delay exist regardless of the profitability or size of the target firm or the shareholder’s disclosed reason for filing. The authors conclude that accelerating the timing of the disclosure window is an improvement that is in the best interest of the general investing public. Originality/value To the authors’ knowledge, this is the only academic study of Schedule 13D filings to include the postpandemic period. As such, the authors establish an updated “baseline projection” for expectations regarding how the Modernization final rule will impact activist investors and stock returns under a five-day reporting regime. In addition, the authors measure and test abnormal returns after considering differences between “triggering” events and filing dates of Schedule 13Ds in the sample rather than grouping all filings. This approach allows the authors to account for the time difference between the triggering event and the filing date.

Cruroplasty as a standalone treatment for recurrent hiatal hernia repair.

Following laparoscopic anti-reflux surgery (LARS), recurrence of hiatal hernia is common. Patients with symptomatic recurrence typically undergo revision of the fundoplication or conversion to magnetic sphincter augmentation (MSA) in addition to cruroplasty. However, patients with an intact fundoplication or MSA may only require repeat cruroplasty to repair their recurrent hiatal hernia. The purpose of this study is to compare outcomes following cruroplasty alone compared to full revision (i.e. redo fundoplication or MSA with cruroplasty) for the management of recurrent hiatal hernias. A retrospective review of patients undergoing surgical revision of a symptomatic recurrent hiatal hernia between February 2009 and October 2022 was performed. Preoperative characteristics, intraoperative details, and postoperative outcomes were compared between patients undergoing cruroplasty alone versus full revision. A total of 141 patients were included in the analysis. 93 patients underwent full revision, and 48 patients underwent cruroplasty alone. The mean time between initial and revisional surgery was 8 ± 7.7years. There was no significant difference in operative time or rates of intra-operative or post-operative complication between groups. Patients undergoing cruroplasty alone had a mean Gastroesophageal Reflux Disease Health Related Quality Life (GERD-HRQL) Questionnaire score of 9.6 ± 10.2 compared to a mean score of 8.9 ± 11.2 for full revision patients (p = 0.829). Recurrence rates following revision was 10.4% for cruroplasty alone patients and 11.8% in full revision patients (p > 0.999). In patients with intact fundoplication or MSA, cruroplasty alone results in similar post-operative outcomes compared to full revision for recurrent hiatal hernia.

Team-, case-, lecture- and evidence-based learning in medical postgraduates training

BackgroundThe aim of this study was to evaluate the effectiveness of team-, case-, lecture-, and evidence-based learning (TCLEBL) methods in cultivating students’ clinical and research abilities, as compared to traditional lecture-based learning (LBL) approaches.MethodsForty-one medical postgraduates were divided into two groups, a TCLEBL group and an LBL group. Teaching effectiveness was evaluated through student- and teacher-feedback questionnaires, scores from theoretical examinations and written literature reviews, and student learning burdens.ResultsCompared to the LBL approach, both teachers and students were more satisfied with the TCLEBL model (p < 0.001 for both teachers and students). The TCLEBL group performed significantly higher on the theory test compared to the LBL group (p = 0.009). There were significant differences between the LBL and TCLEBL groups, respectively, in terms of literature review and citations (12.683 ± 2.207 vs. 16.302 ± 1.095, p < 0.001), argument and perspective (12.55 ± 1.572 vs. 16.333 ± 1.354, p < 0.001), comprehensiveness of content (13.3 ± 2.268 vs. 16.683 ± 1.344, p < 0.001), and scientific rigor and accuracy (10.317 ± 1.167 vs. 12.746 ± 0.706, p < 0.001). There was no significant difference in the total extracurricular time expended between the two groups (323.75 ± 30.987 min vs. 322.619 ± 24.679 min, respectively for LBL vs. TCLEBL groups, p = 0.898).ConclusionsTCLEBL is an effective teaching method that cultivates students’ clinical and research abilities.

Enhanced Area Defense: Magnetic Launcher and Sensor Integration

In this article, the most appropriate design method for a field defense system that operates with magnetic field laws by taking audio and video signals as reference is described. The study is important because it eliminates the operator (soldier) factor in the battlefield. Taking into account the effect of capacitor voltage, capacitance value and accelerator winding inductance value, the main criteria for determining the power supply and armature structure of the electromagnetic launcher are proposed. This proposal is made with MATLAB/Simulink software based mathematical model and the differences are explained by comparing with ANSYS Maxwell simulation. The simulated results show that the speed difference between the models is 7%. Additionally, the design methods of the audio and video-based positioning systems that control the system are explained in the study. In this system where signal receiving microphones are positioned in triangular form, a linear algorithm using the time difference method is utilized. By comparing the theoretical mathematical model with the experimental simulation model, the accuracy of the method and the method function is proved. In this study, a deep learning-based target detection system that operates with the YOLO v2 algorithm is used to increase the system's mission execution capacity. The operator is eliminated by switching the system with the signal received from the positioning systems.

Scaling and interpreting treatment effects in clinical trials using restricted mean survival time.

Restricted mean survival time is the expected duration of survival up to a chosen time of restriction . For comparison studies, the difference in restricted mean survival times between two groups provides a summary measure of the treatment effect that is free of assumptions regarding the relative shape of the two survival curves, such as proportional hazards. However, it can be difficult to judge the magnitude of the effect from a comparison of restricted means due to the truncation of observation at time . In this article, we describe additional ways of expressing the treatment effect based on restricted means that can be helpful in this regard. These include the ratio of restricted means, the ratio of life-years (or time) lost, and the average integrated difference between the survival curves, equal to the difference in restricted means divided by These alternative metrics are straightforward to calculate and provide a means for scaling the effect size as an aid to interpretation. Examples from two randomized, multicenter clinical trials in prostate cancer, NRG/RTOG 0521 and NRG/RTOG 0534, with primary endpoints of overall survival and biochemical/radiological progression-free survival, respectively, are presented to illustrate the ideas. The four effect measures (restricted mean survival time difference, restricted mean survival time ratio, time lost ratio, and average survival rate difference) were 0.45 years, 1.05, 0.81, and 0.038 for RTOG 0521 and 1.36 years, 1.17, 0.56, and 0.12 for RTOG 0534 with = 12 and 11 years, respectively. Thus, for example, the 0.45-year difference in the first trial translates into a 19% reduction in time lost and a 3.8% average absolute difference between the survival curves over the 12-year horizon, a modest effect size, whereas the 1.36-year difference in the second trial corresponds to a 44% reduction in time lost and a 12% absolute survival difference, a rather large effect. In addition to the difference in restricted mean survival times, these alternative measures can be helpful in determining whether the magnitude of the treatment effect is clinically meaningful.

Impact of a Remote Primary Care Telehealth Staffing Model on Primary Care Access in the Veterans Health Administration.

The Veterans Health Administration (VHA) implemented the Clinical Resource Hub (CRH) program to fill staffing gaps in primary care (PC) clinics via telemedicine and maintain veterans' healthcare access. To evaluate PC wait times before and after CRH implementation. Comparative interrupted time series analysis among a retrospective observational cohort of PC clinics who did and did not use CRH during pre-implementation (October 2018-September 2019) and post-implementation (October 2019-February 2020) periods. Clinics completing ≥10 CRH visits per month for 2 consecutive months and propensity matched control clinics. Two measures of patient access (i.e., established, and new patient wait times) and one measure of clinic capacity (i.e., third next available appointment) were assessed. Clinics using CRH were 1:1 propensity score matched across clinical and demographic characteristics. Comparative interrupted time series models used linear mixed effects regression with random clinic-level intercepts and triple interaction (i.e., CRH use, pre- vs. post-implementation, and time) for trend and point estimations. PC clinics using CRH (N = 79) were matched to clinics not using CRH (N = 79). In the 12-month pre-implementation, third next available time increased in CRH clinics (0.16 days/month; 95% CI = [0.07, 0.25]), and decreased in the 5 months post-implementation (-0.58 days/month; 95% CI = [-0.90, -0.27]). Post-implementation third next available time also decreased in control clinics (-0.48 days/month; 95% CI = [-0.81, -0.17]). Comparative differences remained non-significant. There were no statistical differences in established or new patient wait times by CRH user status, CRH implementation, or over time. In a national VHA telemedicine program developed to provide gap coverage for PC clinics, no wait time differences were observed between clinics using and not using CRH services. This hub-and-spoke telemedicine service is an effective model to provide gap coverage while maintaining access. Further investigation of quality and long-term access remains necessary.

Flash Flood Simulation for Hilly Reservoirs Considering Upstream Reservoirs—A Case Study of Moushan Reservoir

With the advancement of society and the impact of various factors such as climate change, surface conditions, and human activities, there has been a significant increase in the frequency of extreme rainfall events, leading to substantial losses from flood disasters. The presence of numerous small and medium-sized water conservancy projects in the basin plays a crucial role in influencing runoff production and rainwater confluence. However, due to the lack of extensive historical hydrological data for simulation purposes, it is challenging to accurately predict floods in the basin. Therefore, there is a growing emphasis on flood simulation and forecasting that takes into account the influence of upstream water projects. Moushan Reservoir basin is located in a hilly area of an arid and semi-arid region in the north of China. Flooding has the characteristics of sudden strong, short confluence time, steep rise, and steep fall, especially floods caused by extreme weather events, which have a high frequency and a wide range of hazards, and has become one of the most threatening natural disasters to human life and property safety. There are many small and medium-sized reservoirs in this basin, which have a significant influence on the accuracy of flood prediction. Therefore, taking Moushan Reservoir as an example, this paper puts forward a flash flood simulation method for reservoirs in hilly areas, considering upstream reservoirs, which can better solve the problem of flood simulation accuracy. Using the virtual aggregation method, the 3 medium-sized reservoirs and 93 small upstream reservoirs are summarized into 7 aggregated reservoirs. Then, we construct the hydrological model combining two method sets with different runoff generation and confluence mechanisms. Finally, after model calibration and verification, the results of different methods are analyzed in terms of peak discharge error, runoff depth error, difference in peak time, and certainty coefficient. The results indicate that the flooding processes simulated by the proposed model are in line with the observed ones. The errors of flood peak and runoff depth are in the ranges of 2.3% to 15% and 0.1% to 19.6%, respectively, meeting the requirements of Class B accuracy of the “Water Forecast Code”. Method set 1 demonstrates a better simulation of floods with an average flood peak error of 5.63%. All these findings illustrate that the developed model, utilizing aggregate reservoirs and dynamic parameters to reflect regulation and storage functions, can effectively capture the impact of small water conservancy projects on confluence. This approach addresses challenges in simulating floods caused by small and medium-sized reservoirs, facilitating basin-wide flood prediction.

Leak detection and localization in underground water supply system using thermal imaging and geophone signals through machine learning

The underground water pipeline system is a crucial infrastructure that largely remains out of sight. However, it is the source of a clean and uninterrupted flow of water for our everyday lives. Various factors, including corrosion, material degradation, ground movement, and improper maintenance, cause pipe leaks, a silent crisis that causes an estimated 39 billion dollars of loss every year. Prompt leakage detection and localization can help reduce the loss. This research investigates the potential of two machine learning models as supporting tools for surveying extensive areas to identify and pinpoint the location of underground leaks. The presented combined approach ensures the speed and accuracy of the leakage survey. The first machine learning model is a hybrid ML model that employs thermal imaging to identify subterranean water leakage. It relies on detecting thermal anomalies and distinctive signatures associated with water leakage to identify and locate underground water leakage. The developed model can detect up to 750 mm underground leakage with 95.20 % accuracy. The second model uses binaural audio from geophones to localize the leakage position. The model utilizes interaural time difference and interaural phase difference for localization purposes, and the 1D-CNN network delivers an angle in twenty-degree increments with an accuracy of 88.19 %. Large-scale implementation of the proposed model could be a powerful catalyst to reduce water loss in the water supply system.

Clinical efficacy of two different doses of rituximab as a treatment option in adult patients with chronic immune thrombocytopenia

BackgroundImmune thrombocytopenia (ITP) is an autoimmune bleeding disorder with a high incidence of chronicity among adults. Rituximab is recommended as a treatment option for chronic ITP with the best long-term effect compared with other therapies. However, the optimal dose of rituximab remains unclear. We retrospectively compared the response rate, incidence of relapse, and other clinical outcomes in 34 chronic ITP patients who received rituximab in different doses. Patients were divided into two groups according to rituximab dose (the low-dose group, 100 mg/week for 4 weeks, and the standard-dose group, 375 mg/m2 weekly for 4 weeks).ResultsFemales represented 72.2% and 56.3% of patients in the low dose and the standard dose groups, respectively. The overall response in all patients was 88.2%. By the end of the second month of treatment, 77.8% achieved partial remission and 11.1% achieved complete remission in the low-dose group versus 68.8% and 18.8% in the standard-dose group. Similar incidence of sustained complete response after 6 months of treatment, 83.3% after low dose rituximab and 81.2% after the standard dose (p = 1.000). The incidence of relapse was similar between both groups.ConclusionOur findings demonstrate that both regimens had no statistically significant differences in overall response, relapse rate, and time to reach response. The low dose of rituximab is comparable to the standard high dose in efficacy and safety for the treatment of chronic ITP patients and can be a good option in centers with limited resources.

Management of immune thrombotic thrombocytopenic purpura without therapeutic plasma exchange

AbstractImmune thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening autoimmune disorder caused by ADAMTS13 deficiency. Caplacizumab, an anti–von Willebrand factor nanobody, is approved for iTTP treatment, reducing the need for therapeutic plasma exchange (TPE) and improving platelet count recovery and survival. We conducted a retrospective study on 42 acute iTTP cases in Austria and Germany, treated with a modified regimen aimed at avoiding TPE if platelet count increased after the first caplacizumab dose. Baseline characteristics and patient outcomes were compared with a control group of 59 patients with iTTP receiving frontline treatment with TPE, caplacizumab, and immunosuppression. The main outcome was the time to platelet count normalization. Secondary outcomes included clinical response, exacerbation, refractory iTTP, iTTP-related deaths, and the time to platelet count doubling. The median time to platelet count normalization was similar between the 2 cohorts (3 and 4 days; P = .31). There were no significant differences in clinical response, exacerbations, refractoriness, iTTP-related deaths, or time to platelet count doubling, reflecting the short-term treatment response. Four patients did not respond to the first caplacizumab dose, and TPE was subsequently initiated. Cytomegalovirus infection, HIV/hepatitis B coinfection, an ovarian teratoma with associated antiplatelet antibodies, and multiple platelet transfusions before the correct diagnosis may have impeded the immediate treatment response in these patients. In conclusion, caplacizumab and immunosuppression alone, without TPE, rapidly controlled thrombotic microangiopathy and achieved a sustained clinical response in iTTP. Our study provides a basis for TPE-free iTTP management in experienced centers via shared decision-making between patients and treating physicians.

Randomized Trial of Postoperative Radiation Therapy After Wide Excision of Neurotropic Melanoma of the Head and Neck (RTN2 Trial 01.09)

Abstract Background Cutaneous neurotropic melanoma (NM) of the head and neck (H&amp;N) is prone to local relapse, possibly due to difficulties widely excising the tumor. This trial assessed radiation therapy (RT) to the primary site after local excision. Methods Participants from 15 international centers were randomized to observation or RT. The participants were required to have microscopically negative excision margins 5 mm wide or wider and no evidence of disease elsewhere. The primary outcome was time to local relapse. The secondary outcomes included time to any recurrence, overall survival (OS), and toxicity. Results The trial ceased prematurely due to slow recruitment and the COVID-19 pandemic. During 2009–2020, 50 participants were randomized: 23 to observation and 27 to RT. The most common NM subsites were scalp (32%), midface (22%), and lip (20%). The median depth of invasion was 5 mm, and desmoplasia observed in 69%. The median duration from randomization to last contact was 4.8 years. Four participants (8%) experienced local relapse as a first recurrence during the study period: 3 in the observation arm and 1 in the RT arm (hazard ratio [HR] 0.29; 95% confidence interval [CI] 0.03–2.76; p = 0.279). No statistically significant difference in time to any relapse or OS was observed. More than 6 months after randomization, grade 3 or greater toxicity was experienced by 10% of the participants in the observation arm and 12.5% of the participants in the RT arm of the study. Conclusion Due to low accrual, the role of adjuvant RT for cutaneous NM of the H&amp;N excised with microscopically negative margins 5 mm wide or wider remains undefined. Its routine use cannot be recommended. Local relapse might be less common than previously anticipated based on retrospective reports.

Sex-specific relationship patterns between body morphology and maturity status with change of direction and agility in elite adolescent volleyball players

This study explored sex-specific patterns in the relationship between maturity, body morphology, and change of direction (COD) and agility (AG) in adolescent volleyball players. The sample comprised 22 males and 24 females aged 15–17 with at least 4 years of sports experience. Measurements included body height, weight, muscle and fat mass, leg length, and center of mass. The study determined the Age of Peak Height Velocity (APHV) and evaluated sensorimotor ability through pre-planned COD and not-planned AG five-time shuttle runs, measuring the time difference as the index of reactivity. Positive correlations were found between COD and AG with fat mass index (FMI) in boys, while negative relative lower limb length (rLL) correlated with COD. In females, age of peak height velocity (APHV) showed a significant negative relationship with sensorimotor ability. Linear and polynomial regressions confirmed predictive and curvilinear relationships, respectively. Cluster analysis identified different associations in boys and girls, emphasizing sex-specific patterns. Body fat percentage had a negative impact on COD-AG in boys, while the optimal lower limb length proportion positively influenced COD due to enhanced maneuverability. Maturation affected sensorimotor abilities in girls. The findings suggest a need for a tailored approach to COD-AG development based on sex-specific considerations in adolescent volleyball players.

Evaluating the relationship between health-related social needs, patient demographics, and access to biologics in patients with moderate-to-severe asthma in Bronx, NY

Objectives This study assesses the relationship between patient age, gender, race, socioeconomic status, social determinants of health (SDoH), and access to biologics (products isolated from natural sources that target specific molecules, proteins, and cells) in patients with moderate-to-severe asthma in Bronx, NY. Methods Cohort of 289 patients with moderate-to-severe asthma treated at Montefiore Medical Center (MMC) from 2018 to 2020 was used. Patient demographics, self-reported social needs, and neighborhood socioeconomic characteristics were analyzed. Neighborhood socioeconomic status was estimated by determining median income in patients’ residential zip codes using 2020 Census data and grouping patients based on whether neighborhood median income was above or below New York State (NYS) median ($71,117/year). Area Deprivation Index tool (ADI) was used as an additional measure of neighborhood socioeconomic status. Results Patients living in regions with incomes below NYS median found to have longer wait times between biologic approval to administration than patients living in regions above median income (p = 0.012). Mean time from insurance approval to biologic administration was significantly different between Black and Latinx patients (p = 0.009). No significant difference found for patient regional income status and time from biologic prescription to approval. No significant differences in access to biologics were found for age, gender, number of health-related social needs, or patient ADI quartile. Conclusions Patients who live in areas of NYC where median income is below NYS median are more likely to experience delays in access to biologics, specifically due to time between approval and administration of medication.